Autoimmune Disorders

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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Specific autoimmune disorders with rising frequency:

As we see a rising frequency of both diagnosed and undiagnosed autoimmune disorders in the United States, and in the world, we see that there is considerable incidence of a patient diagnosed with more than one autoimmune disorder, with one autoimmune disorder apparently caused by another, and a considerable variance in clinical symptom presentation and course of the disease for many autoimmune presentations. This does point to a need to view these autoimmune disorders primarily as a dysfunction of the immune homeostasis and not as much as specific diseases. A more holistic approach to treatment and prevention is sorely needed. More and more sound scientific research is proving that the array of treatment protocols used in Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM) are effective for an array of goals in the adjunct care of autoimmune disorders, and this information and links to these studies are available in the section of this article entitled Additional Information. Clear goals of therapy should be defined and individualized courses combining a variety of therapies should be devised to meet these goals, requiring a proactive and informed effort on the part of each patient. Ignoring the varied needs of therapy in autoimmune disease and the complexity of these disorders, just trusting a single drug to take of you is proven to be inadequate for most patients, leading to a poor long-term outcome and management of health. 

Angioedema (blood vessel swelling) is a symptom that may be related to an autoimmune disorder, and is characterized by swelling beneath the skin or in the mucous membranes, usually occurring in the throat, around the lips or eyes, or on the hands or feet. It is rapidly moving from a very rare occurence, to one that is increasingly seen in the United States population. Incidence has moved from one in 150,000, to one in 50,000, and is considered grossly underdiagnosed, due to the unfamiliarity with the disorder, and the difficulty in diagnosing. This disorder manifests in episodes, often short in duration, and sometimes alarming or life threatening. The episodes may come with some frequency and then dissappear for years. While many cases are diagnosed as inherited, or hereditary (HAE), even cases linked to specific genetic missense display a variety of types, are usually multifactorial in cause, and are poorly understood. Specific typing helps in the diagnosis, telling us differences in levels of control proteins, called C1, or C1-INH, which may or may not be abnormal, or whether estrogens play a significant role in the pathophysiology, but this typing mainly helps decide the pharmacological approach in allopathic medicine, which to date has been ineffective. The workable approach to treatment must focus on all of the underlying health problems and tackle the disorder with a comprehensive and holistic approach. Integrating Complementary Medicine, especially with acupuncture, herbal and nutrient medicine, may make a dramatic difference. Traditional Chinese Medicine is normally focused both on underlying health problems that cause or contribute to the pathology as well as symptom relief, and the array of treatments and medicines is broad and varied, unlike allopathic medicine. While angioedema is still downplayed as a symptom related to allergic reaction, in most cases the actual cause of the angioedema is never found, and the syndrome is termed idiopathic. It is true that acute angioedema may be caused be an allergic reaction to medications (antibiotics, especially sulfa drugs, NSAIDS (nonsteroidal anti-inflammatory drugs), and blood pressure medications such as ACE inhibitors), by allergic reactions to insect bites, pollen, animal dander, or a variety of foods, or by exposure to extreme cold or heat, chronic cases of angioedema usually fall within the category of an autoimmune disorder. Episodes of difficult breathing due to airway obstruction from swelling is what usually brings this disorder to the attention of rheumatic specialists. Chronic episodes of facial or extremity swelling, or purpura to the lower legs, are often ignored by the patient, and resolve spontaneously. Medical doctors too often recommend avoidance of potential foods that may stimulate an allergic reaction, resulting in difficult nutrition and anxiety disorder.

Polymyositis, Dermatomyositis, and Inclusion Body Myositis are related autoimmune disorders seen with increasing frequency in recent years. These poorly understood and complex disorders are highly associated with other autoimmune disorders such as Lupus, Scleroderma, and Rheumatoid Arthritis, and involve both humoral immune responses (antibodies produced by B cells) and a cell-mediated complement immune response (T cell mediated). Theories of Th1/Th2 imbalance and a neurohormonal immune missense are applicable in many cases. Antibodies are found in a high percentage of patients but are varied and non-specific for myositis, often associated with other autoiummune disorders. Cytokines most associated include IL-1 alpha, IL-1 beta, and TGF beta 1-3, derived from T cells. More recent studies implicate both TNF-alpha, IL-1 and IL-10 polymorphisms as genetic risk factors. A high percentage of cases reveal viral infection with various Cocksackie B viral strains. It is believed by many experts that these autoimmune muscle diseases often progress slowly and go undiagnosed, especially in the older population. Muscle weakness and wasting (dystrophy), discolored skin, lung inflammation, and overload of the kidneys are often the signs that lead to diagnosis. Muscle weakness usually starts in the proximal muscles of the limbs, and manifests as slowly increasing difficulties climbing stairs, rising from a seat, reaching overhead, and lifting objects. Shortness of breath, difficulty swallowing, arthritis, and arrythmias are often noticed. Calcium deposition in the muscles and skin is often seen, and may be related both to manifestation and causative factors. These are considered highly related to collagen-vascular diseases. There is no known cure, and the Cleveland Clinic recommends a comprehensive treatment strategy, with physiotherapies, heat therapies, medication and rest added to the usual immune suppressing and corticosteroid medications. The comprehensive treatments provided by many Licensed Acupuncturists may provide such approaches and complement the standard treatment well. Herbal medicine provides some adjunct therapies that may be valuable. For instance, the Chinese herb Lei gong teng (Trypterygium wilfordii) is a potent dose-dependent inhibitor of IL-1 alpha and beta, and Boswellia serata (Ru xiang) and Salvia miltiorrhiza (Dan shen) are potent dose-dependent inhibitors of TGF-beta. A variety of herbs and herbal chemicals may provide both inhibition of the Th1 cytokines that drive the disease mechanism and help clear deep low-grade viral infections that have caused, and may be perpetuating the autoimmune responses. Further research may reveal a number of specific herbal chemicals that may address the underlying pathological factors in Dermatomyositis. Since standard pharmaceutical treatment involves harsh drugs, such as corticosteroids and immunosuppressants, Complementary Medicine may help to alleviate side effects of these drugs as well.

Sjogren's Syndrome is becoming one of the most prevalent autoimmune disorders seen in the population of the United States in the last decade. Some rheumatologists have classified Sjogren's disorder and myositis as variants of Lupus, an autoimmune disorder with a long history and a broad array of clinical manifestations. Sjogren's disorder, or syndrome of dysfunction, was formerly called Sjogren's Disease, until the high occurrence prompted enough research to reveal that this disorder is actually a syndrome of dysfunctions, not a specific set of symptoms defined by a single disease mechanism. Sjogren's Syndrome is a chronic autoimmune disorder manifesting most often as dry eyes and other membranes, and affecting our blood vessels, gastrointestinal system, central nervous system, liver, kidneys, lungs and pancreas. Over 400,000 Americans have been diagnosed with Sjogren's Syndrome, and many experts believe that the majority of sufferers have not been diagnosed. This syndrome affects predominantly women, with 9 of 10 diagnosed cases seen in females, implying a neurohormonal immune dysfunction. Over half of the diagnosed cases are secondary to other autoimmune disesases, particularly rheumatoid arthritis, lupus, or scleroderma. While the patient and their doctor often focuses on the dry eye syndrome, all cases of Sjogren's Syndrome are systemic, and a persistent and comprehensive approach to therapy is needed. Symptoms often go into remission and reemerge during times of increases stress as the immune system health waxes and wanes. Standard therapy uses artificial tears, anti-inflammatory drugs, and sometimes surgical procedures to improve the symptoms of the dry eyes and mouth, but these do not affect the underlying problems. A growing number of in vivo studies, and human clinical trials, with randomized studies of acupuncture and herbal medicines compared to standard therapy, have demonstrated proof of the effectiveness of these therapies. A meta-review of randomized controlled human clinical trials of Chinese Herbal Medicine as an adjunct integrative therapy for Sjogren's Syndrome, in 2011, found 52 such studies and proof of effectiveness. The adverse effects were very mild, with some patients experiencing diarrhea from the herbal formulas, and the quality of the studies was still relatively low, but proof of benefits are there. To see this study, click here: http://www.ncbi.nlm.nih.gov/pubmed/21419078 .These therapies in Complementary and Integrative Medicine (CIM/TCM) are not an alternative to standard therapy, but do provide a variety of treatment protocols that not only improve symptoms but get at the underlying health problems.

A knowledgeable professional should be utilized to provide this care and insure that quality herbal medicinals are used, with utilization of nutrient medicines to improve lacrimal content, antioxidant effects, and bioavailability of chemicals for optimum immune function. So far, therapy with synthetic hormones has not been proven effective. Reestablishing a balance between the T-helper cell 1 and 2 functions (Th1/Th2) is the focus of much of the current research. The diagnosis of Sjogren's includes a histological and serotological analysis of the contents and structure of the lacrimal and salivary glands. Histopathological findings reveal that there is a great similarity in lymphocytic infiltration and degeneration of the parenchyma (organ tissue) between Sjogren's Syndrome and chronic autoimmune thyroiditis syndromes. Thyroiditis-related antibodies were found in 20-35% of salivary and lacrimal tissues and fluids, and approximately 30 percent of confirmed cases of Sjogren's Syndrome presented chronic thyroiditis as a complication (PMID: 2754526). Sytemic production of autoimmune antibodies to peptides of RNA and DNA, SS-ARo and SS-B/La, is seen, as well as a variety of autoantibodies and cytokines that serve as diagnostic markers. As these autoimmune processes slowly progress, the mucosal surfaces become sites of chronic inflammation that stimulate autoimmune progression. Early treatment intervention is important.

Vitiligo, or loss of pigment-producing melanocytes in the skin, is a common autoimmune disease that often occurs secondary to another autoimmune disease, such as psoriasis or autoimmune thyroiditis (Hashimoto's). The pathology of vitiligo is still unclear, despite decades of research, and appears to be a complicated array of factors. Research in 2011 (cited below) by the Laboratory of Cutaneous Physiopathology of San Gallicano Dermatologic Institute in Rome, Italy, and the Unversity of Amsterdam, Netherlands Institute for Pigment Disorders, proved that there is a strong link between the cutaneous and systemic antioxidant systems and levels in vitiligo pathology. These levels of glutathione, catalase, CoQ10 and superoxide dismutase also changed according to the stage of the disease, or skin phototypes 2 to 7. The conclusion of these experts was that there was more to the pathology of vitiligo than just the autoimmune destruction of melanocytes and melanin metabolism (PMID: 22081894). Melanocytorrhagy is the term now used to best express the causative effects of oxidant stress, where reactive oxygen species are believed to create new antigens that are melanocyte-specific, and combine with hypoxia, autoimmune destruction of melanocytes, and neurogenic dysregulation, to either destroy melanocytes, prevent cell adhesion, or inhibit melanocyte function. To treat such a systemic disease mechanism an array of treatments in a holistic regimen is needed. Use of CoQ10, methylselenocysteine, and other antioxidants supporting glutathione metabolism should be combined with specific herbs (internal and topical application), acupuncture stimulation, immune stimulation, and restoration of the melanin production, utilizing L-tyrosine, P5P, zinc monomethionine, and milk thistle.

Systemic Lupus Erythematosus (SLE) is perhaps the fastest growing autoimmune disease in the United States and perhaps the most poorly understood. The term Lupus Erythematosus literally refers to the wolf-like red patterning on the skin of the face, and goes back to the 13th century, where Rogerius described the facial lesions reminiscent of a wolf bite! Lupus has risen in incidence in the female population, and especially in the black female population, to over 200 per 100,000 new yearly cases by 2014, and predominantly affects young women, with periods of exacerbation and remission. Experts at the University of Michigan reported in 2014 that "there were substantial racial disparities n the burden of SLE, with black patients experiencing earlier age at diagnosis, a greater than 2-fold increase in SLE incidence and prevalence, and increased proportions of renal disease and progression to end-stage renal disease as compared to white persons" (PMID: 24504809). Since the diagnosis of SLE is very difficult, and the signs and symptoms so variable, it is believed that a large number of individuals with SLE remain undiagnosed. In the past, estimates of incidence in the United States ranged from 500,000 to 1,500,000, and even today, more intense study produces data that is almost impossible for the average person to understand, but it is agreed that the incidence is much higher in the recent past than previously estimated by at least 2-fold, and some estimates say 4-fold. There are numerous genetic propensities identified, mainly in the Major Histocompatability Complex (MHC), or genetic immune memory, which passes information concerning what is human and what is not, of course, although most studies identifying genetic loci are not reproducible in studies of different ethnic groups. The subject of genetic inheritance is not clear, and the large predominance in minority populations bring up questions of the environment and diet. The predominance in women leads us to explore the hormonal factors that are associated, a relative excess of estrogens (progesterone deficiency) is consistently noted. A deficiency of androgens, from DHEA to testosterone is frequently seen in studies as well, implying that SLE is highly associated with adrenal deficiency or adrenal stress syndromes. High levels of prolactin, a hypothalamic-pituitary hormone, have also been found in significant percentage of SLE patients, and this may be linked to the level of immune response, as prolactin correlates with higher disease activity and higher levels of estrogen stimulation of B cell activation in immune diseases. Adrenal stress and a defective hypothalamus-pituitary-adrenal axis is associated with SLE, with lowered cortisone responses. While the direct link causally is unclear with hormonal imbalances and lupus, it is certainly clear that they play a significant role in the progression of the disease. Vasculitis, vascular occlusion, and a variety of autoimmune markers, such as ANA (anti-nuclear antibodies), IgG, and coagulation factors are seen in a large majority of cases. Protection against kidney disease and dysfunction should be a prominent goal of the holistic therapy. Heightened numbers of B cells and B cell activity precede the onset of SLE, and it is thought that a variety of antigens, pathogens, cytokines and other stimuli of B cells are a key to the pathology. As with most autoimmune diseases, this leads to a Th2 dominance over Th1 in T cells responses, and specifically IL-10 excess and IL-12 deficiency is seen. Poor regulation of the immune responses is a hallmark of SLE. Environmental factors that may cause or worsen SLE include a number of common medications, including synthetic hormones, penicillamine, isoniazid (TB antibiotic), procainamide (anti-arrhythmic), a number of high blood pressure medications (hydralazine), antipsychotic medications (chlorpromazine), seizure medications (phenytoin), aromatic amines (prilocaine, a local anesthetic), plus hydrazines (in jet and rocket fuel and polymers), hair dyes and xenoestrogens. Dietary intake of high levels of saturated fats, chronic bacterial endotoxins, and retroviruses (e.g. Herpes) are also linked to the pathology. A number of Chinese herbs have been studied and confirmed to provide relief or protection against kidney disease and dysfunction in Lupus patients.

Graves' Disease is a thyroid-specific autoimmune disorder that involves antibodies to the TSH (thyroid stimulating hormone) receptors, and often other autoimmune antibody response, much like Hashimoto's thyroiditis. Graves' Disease, though, leads to a chronic and threatening hyperthyroid state, while the vast majority of Hashimoto's cases soon result in a hypothyroid state. TSH is a hormone created and released by the hypothalamus-pituitary neurohormonal complex, within the feedback cycle of the adrenal axis. The anti-TSH receptor IgG antibody is able to stimulate the TSH receptors and create an excess of thyroid hormone release outside of this feedback cycle control. Common symptoms include goiter (enlarged thyroid gland), weight loss, trembling and twitch, and a rapid heart rate. More chronic and severe cases eventually result in classic signs such as bulging eyes and swollen lower extremities, even with standard treatment. Immune dysfunction includes chronic inflammation and lymphocyte excess, and these in turn stimulate the thyroid glands to produce an excess expression of TNF-alpha, IL-1, IL-6, adhesion molecules and interferon. A Th2 dominance over Th1 T-helper cells is a hallmark of the immune imbalance. Standard treatment of the disease involves thyroid suppression with antithyroid drugs and radioactive iodine, or partial or full removal of the thyroid glands with a lifelong dependency on synthetic thyroid hormone. Often, Graves' Disease progresses slowly and goes into remission, though, and restoration of the thyroid and immune homeostasis can be enhanced with therapeutic protocols in Complementary and Integrative Medicine (CIM/TCM). Each patient needs to assess their individual condition and decide when it is appropriate to integrate more conservative therapies to try to achieve this health restoration. Graves' Disease often goes into remission during pregnancy, which has led to much research into the mechanisms that trigger this remission. Such research provides CIM/TCM with more and more evidence on which to base a wide array of safe and effective therapies in a more complex and individualized holistic protocol.

Addison Disease is a type of primary adrenal insufficiency that may or may not be due to an autoimmune response. Autoimmune Addison's Disorder is due to reactivity to the adrenal cortex involving both antibodies and T cells. There is a complex and poorly understood genetic susceptibility to Addison's Disease, and even less understood environmental causes, and recent research is uncovering genetic links to endogenous lectins, as well as metabolic links. The incidence of Addison Disease in the United States has risen considerably in the last decade, and diagnosis is often uncertain. Incidence in the U.S. and Europe had doubled from the 1960s to the end of the 1990s, and an inexplicable rise occurred in the 21st century. Obviously, better protocols are needed to prevent occurrence. Autoimmune Addison Disease is often associated with, or secondary to, other autoimmune diseases, including thyroiditis, Graves' Disease, Vitiligo, and diabetes, as well as hypoparathyroidism, TB, chronic fungal infections, and tumors. Common signs of Addison Disease are areas of darkly pigmented skin, dehydration, dizziness when standing up, fatigue, craving of salt and reduced appetite. Tests often show low cortisol levels, low sodium and high potassium in blood, acidity (low pH), and low blood pressure, as well as elevated ACTH levels, but should be confirmed with a cosyntropin stimulation test to confirm the diagnosis. Standard treatment involves taking synthetic cortisone and corticosteroids for life, which come with considerable adverse health effects over time. Poor control of dosage of these drugs often leads to thyroiditis, diabetes, anemia, and hypoparathydroidism, as well as episodes of adrenal crisis, with difficulty breathing, dizziness, low blood pressure and reduced level of consciousness. Universal guidelines call for the lowest effective dosage of these harsh synthetic hormones, and CIM/TCM therapy can help achieve a lower effective dosage. Intelligent support therapies can support adrenal function, allow for lower dosage of medications, and alleviate or prevent comorbid health conditions. A knowledgeable Licensed Acupuncturist and herbalist will be able to safely provide adjunct care that will greatly improve quality of life, now, and more importantly, in the future. Some studies have confirmed that DHEA therapy may improve symptoms, but most often direct DHEA has decreased effects over time due to adaptation in a hormonal feedback regulation. Use of bioidentical pregnenelone cream and adrenal cortex is a healthier and more effective way to achieve this same increase in DHEA and adrenal function, and short courses of acupuncture could improve the outcomes in a synergistic manner. Over half of all patients with Addison Disease undergoing standard therapy develop another autoimmune disease, and treatment to improve immune health and function may prevent this.

Comorbid autoimmune diseases occur often in patients with chronic Addison Disease, especially Polyglandular Autoimmune Disorder, and are often accompanied by chronic Hypoparathryoidism and chronic Candidiasis, an acknowledged quartet of related health problems, that are now grouped as Type 1 and 2 Polyglandular Autoimmune Addison Syndrome. By 2014, Polyglandular Autoimmune Syndrome Type 2 (PGA-2) is considered by most experts in rheumatic disease to be the most common of the immunoendocrinopathy diseases, and is defined by chronic Addison Disease accompanied by thyroid autoimmune disease, usually termed Hashimoto's, often subclinical, and autoimmune Diabetes Type 1, and usually has one or more of the following comorbid conditions, Celiac Disease, Graves' Disease, hypogonadism, and chronic fatigue. The now prevalent trio of Addison Disease, Graves' Disease and insulin dependent Type 1 Diabetes Mellitus is referred to as Carpenter Syndrome, and almost all patients are diagnosed in their late 30s and 40s, affecting equally men and women. The now common trio of Addison Disease, autoimmune hypothyroidism and often Type 1 Diabetes is termed Schmidt Syndrome, affecting predominantly women and with a diagnostic incidence of 5 in 100,000. 

Most often these comorbid conditions occur gradually over time, despite the chronic use of cortisone and corticosteroid medication in the treatment of Addison Disease, or perhaps because of it. The clear conclusion is that patients diagnosed with Addison Disease, and Graves' Disease, which are increasing in incidence dramatically, obviously need a more thorough and holistic approach to treatment. The PGA-1 trio of Addison Disease, chronic systemic Candidiasis, and Hypoparathyroidism (often with subclinical hypothryoidism), is still considered a rare disorder, but this may be due to lack of a sound diagnostic workup and guidelines, and the insistence that one has to have the autosomal resistant genetic trait called the AIRE gene mutation. It is now acknowledged that President John F. Kennedy had PGA-1, and despite his access to the best medical care in the world, this was not acknowledged and treated properly. It is obvious today that many people without this double copy of the supposed AIRE gene mutation have PGA-1, and once there are some actual Biologics developed to treat this disorder we will see a lot more diagnosis. 

Today, people with this combination of combordid conditions are not receiving adequate treatment, and use of corticosteroid medications come with a very high incidence Candidiasis, diabetes, Metabolic Syndrome, and other related chronic disorders. Integration of Complementary Medicine in the form of CIM/TCM could prevent and greatly help with treatment of these conditions. Standard treatment at present involves a polypharmaceutical approach with glucocorticoid replacement, corticosteroids, synthetic thyroid hormone (levothyroxine), and and array of medications and insulin to treat diabetes, and often more to treat complications of diabetes, as well as an array of cardiovascular medications. To avoid this problematic polypharmaceutical treatment would be preferrable, as the long list of common adverse health effects, euphemistically called 'side effects' with chronic use is often devastating to the quality of life.